What foreign and some American child psychiatrists find particularly horrifying about is the large number of children in the foster care system - who clearly have developmental issues based on abusive and neglectful homes - receiving the diagnosis of PBD and being put on antipsychotics to control anger and behavioral problems. In most cases this involves a cocktail of three to four drugs. In my experience, it's quite rare for them to be given a single medication (the reality is that antipsychotics don't work that well in children - they have little therapeutic effects other than sedation). Typically, in addition to the antipsychotic, they will be given an anti-seizure medication (used commonly in adult bipolar patients), an antidepressant, lithium, and/or clonidine (a blood pressure medication that calms children by dropping their blood pressure).
Why Are American Psychiatrists Diagnosing PBD
Dr Peter Parry puts the blame for the dangerous fad of prescribing unapproved antipsychotic drugs for children squarely where it belongs: on multinational drug companies and US insurance companies. While internal memos (see http://www.blackdoginstitute.org.au/docs/PaediatricbipolardisorderacontroversyfromtheUSA.pdf slides 91-94 and 98-100) show that drug companies deliberately set out to expand sales of antipsychotics by persuading doctors to prescribe them off-label to kids, the intrusion of for-profit insurance companies into US health care delivery has clearly played a role in perpetuating the barbaric practice. Even where a child has severe emotional problems, insurance companies refuse to pay for psychiatric visits or hospitalization without a diagnosis of mental illness. Moreover only drug treatment is covered, even if the difficulties result from family problems.
Psychiatric Researchers on the Drug Industry Payroll
Meanwhile child psychiatrists who feel uneasy prescribing dangerous antipsychotic medication to children are cheered on by pre-eminent researchers in their field, who issue stern warnings about ruining a child's future life by "missing" the diagnosis. Unfortunately most of the self-proclaimed pediatric bipolar disorder (PBD) experts neglected to disclose that they had a conflict of interest, in the form of hundreds of thousands of dollars in research grants and consultant fees from the drug companies who produce antipsychotics. This has only come out in subsequent lawsuits (see http://www.psychsearch.net/lawsuits.html) and ethical investigations (http://www.cchrint.org/cchr-issues/the-corrupt-alliance-of-the-psychiatric-pharmaceutical-industry/).
In addition to pressure from insurance companies and PBD experts, child psychiatrists and pediatricians also experience major pressure from parents, owing to massive direct-to-consumer marketing -- in the form of dozens of books, magazine articles and TV documentaries promoting PBD as the only explanation for severe behavioral problems -- and a magic pill as the easy answer. Many of these parents, convinced by all the media hype, feel justified in demanding doctors prescribe these wonder drugs for their kids. Pity the poor child psychiatrist who stands firm on recommending the appropriate, evidence-based treatment - a lengthy course of family or behavioral treatment that isn't covered by insurance.
Death and Other Dangerous Complications
The complications of antipsychotic treatment in children fall into four broad categories: death, severe medical complications, social exclusion and delayed emotional development.
1. Death
As Dr Parry points out in his slideshow, fifteen years of FDA adverse incident reports (which typically capture only 1% of adverse drug events) reveal that antipsychotics are directly implicated in the death of scores of children:
2000-2004: 45 deaths (source http://www.usatoday.com/news/health/2006-05-01-atypical-drugs_x.htm)
2006: 29 deaths (source http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1)
2. Severe Medical Complications
Antipsychotics tend to cause massive weight gain -- often as much as 100 pounds -- which commonly leads to diabetes. In addition a disfiguring neurological disorder called tardive dyskinesia that occurs in 6-9% of children who take antipsychotics. The tics and writhing movements associated with tardive dyskinesia often persist permanently, even after the medication is stopped.
3. Social exclusion
Labeling a child with a mental illness, particularly if they are taking a medications that cause sedation, extreme weight gain and/or tics has an extremely detrimental effect on their social relationships, which are absolutely vital to normal child development.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
3
1
1
